Unequal access to cancer drugs breeds frustration

BERLIN (Reuters) - The excited buzz surrounding new drugs at Europe's largest cancer meeting may turn to frustration in doctors' clinics.

The reality for patients is that getting hold of new cancer drugs - some of which offer a few more weeks of life at sky-high costs - depends on where you live.

With Europe's state-backed health systems battling to curb costs in the face of budget squeezes and recession, and drug companies needing to make a profit on ever more complex and narrowly targeted medicines, price is a big issue in cancer.

The result, says Jose Baselga, president of the European Society of Medical Oncology, is an "unbearable" situation where a cancer patient in Spain or Britain may not get a potentially life-saving treatment that is available to someone with the same disease in France or the Netherlands.

"When it comes to drug access, the citizens of the European Union are not equal," he told Reuters at the ECCO-ESMO cancer congress in Berlin.

"It is not desirable to have local decisions. We are a European Union and we should have a regulating body that is central."

According to a study by Sweden's Karolinska Institute earlier this year, the wide disparities in cancer care translate into equally wide gaps in relative survival rates.

In Sweden, for example, 60.3 percent of men and 61.7 percent of women diagnosed with cancer survive for five years, compared with only 37.7 percent of men and 49.3 percent of women in the Czech Republic.

The study found that patients in Austria, France and Switzerland have the widest access to newer cancer treatments, while Poland, the Czech Republic and Britain lagged behind.

"What's absolutely for sure is that patients who are socially deprived or from an ethnic minority will continue to get the worst possible cancer care," said Gordon McVie, senior consultant at the European Institute of Oncology in Milan.

Cancer drugs are already the biggest category of drugs by sales, with global revenues of $48.2 billion in 2008 and an annual growth rate of 11.3 percent, or more than twice the overall industry average, according to research firm IMS Health.

The total pharmaceutical market last year was $773 billion.

REGULATORS, WATCHDOGS AND DESPERATE PATIENTS

Some of the costliest drugs can cost thousands of euros a month for each patient: in colon cancer, Roche's Avastin costs 2,242 euros ($3,300) a month in France, while Vectibix from Amgen and Erbitux from Merck KGaA both cost around 4,000 euros ($5,900) a month ex-factory in Europe.

Those prices are less than in the United States, but the discount doesn't guarantee that modern cancer drugs are seen as good value by European governments and state-backed insurers.

While the European Medicines Agency (EMEA) - the equivalent of the U.S. Food and Drug Administration - decides if new drugs should be licensed across the Europe, the decision on paying for them lies with national health authorities.

That second stage is often fraught as more countries emulate the model of Britain's National Institute for Health and Clinical Excellence in assessing cost-effectiveness.

EMEA Executive Director Thomas Lonngren said earlier this month he saw room for a more coordinated approach between the regulator and such watchdogs - but he doesn't see a pan-European solution on access any time soon.

Alexander Eggermont, president of the European Cancer Organisation, agrees that this all combines to produce "a grave disparity" in treatment, although he points out that drugs are only one element of the equation.

Advances in diagnosis, surgery and radiation therapy are also a big part of the picture - and the cost.

"What you see is people crying out for the latest very expensive, marginally effective drug to be imported into their country and made available," Eggermont told Reuters.

"(But) drug pricing is only a part of the story. We are doing more surgery and more radiation therapy than ever before, meaning that on all levels cancer care cost increases are enormous. People who only got treated once 10 years now get four, five or six different treatments."

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